Modeling the cytotoxicity of Romidepsin reveals the ineffectiveness of this drug in the "shock and kill" strategy.

The "shock and kill" strategy is being widely explored to purge Human Immunodeficiency Virus (HIV) latent reservoirs. Romidepsin, a kind of latency-reversing agents (LRAs), has been shown to induce HIV RNA transcription. However, several clinical trials testing this drug have resulted in limited effect in reducing the HIV latent reservoirs. To understand the mechanisms underlying such limited effect, we develop a multi-scale model that incorporates pharmacokinetics and considers the toxicity of romidepsin to T cells in this paper. By fitting the model to the viral load data from plasma of six patients received romidepsin, we find that the model with T cell toxicity of romidepsin can well explain the clinical data. The dynamics of latently infected cells during romidepsin administration are explored using the best-fit parameter values. The results show that latently infected cells decrease very slowly and remain very stable overall in four of the six participants under the assumption of T cell toxicity of romidepsin. This implies that the ineffectiveness of romidepsin on latent reservoirs can be explained by its toxicity to T cells. In the remaining two participants, however, latently infected cells are quite stable without T cell toxicity of LRAs. It is found that the estimated activation rate of latently infected cells by romidepsin and the estimated elimination rate of romidepsin on immune cells for these two patients are very different from those for the other four patients. Thus we speculate that the heterogeneous response to romidepsin across participants may also be a determining factor of the effectiveness of romidepsin. These results may have significant implications in the search for the control of HIV infection. • An HIV model is proposed to understand the cause of ineffectiveness of romidepsin in the "shock and kill" strategy. • The model has a good fit to patients' data when T cell toxicity of romidepsin is considered. • The toxicity of romidepsin to T cell may contribute to the ineffectiveness of "shock and kill" strategy concerning romidepsin. [ABSTRACT FROM AUTHOR]